Comparing Home Care With Residential Care Expenses

Many families ask the same plain question: is it cheaper to get help at home, or to move to a care home? The honest answer is: it depends on how much help you need each week. Home care is billed by the hour, so it starts cheap and grows with each added hour. Residential care is one monthly fee, and that fee bundles the room, the meals, and staff on site. This guide puts the two side by side, with real national figures, so you can run the sums for your own family.

This guide is part of our Aging at Home hub. Its sister guides cover estimating the cost of help at home, budgeting for expenses Medicare may not cover, and understanding long-term care insurance documents.

Key takeaways

• Home care had a national median rate of $35 per hour in the CareScout Cost of Care Survey 2025.
• Assisted living had a national median of $6,200 per month in the same survey.
• At the median rate, ten hours of home care a week costs about $1,517 a month. Forty hours a week costs about $6,067 a month — close to the full assisted living fee.
• Home care does not replace your house costs. You still pay for food, heat, light, repairs, and taxes on the home.
• Residential care bundles housing and meals into one fee, but added care can cost extra. Ask what the base fee covers.
• Original Medicare does not pay for long-term custodial care, at home or in assisted living. Most families pay these costs themselves.

What you pay for with home care

With home care, you pay for the hours an aide is with you. The aide can help with baths, dressing, meals, light house work, and rides. You choose how many hours to buy. That choice is the whole cost story: a few hours a week is a small bill, and round-the-clock help is a very large one.

What the hourly fee does not cover is the home itself. You still own or rent the house, so you still pay for:

So the true cost of care at home is the aide bill plus the cost of running the home. Leave the house costs out, and home care looks cheaper than it is. Family time counts too: relatives often fill the gaps between aide visits, and that time is real, even if no bill comes for it.

• Food and household goods.
• Heat, light, water, and phone bills.
• Repairs, yard work, and home upkeep.
• Property tax and home insurance, if you own the home.

What you pay for with residential care

Residential care — in this guide, assisted living — works the other way. You pay one monthly fee. That fee bundles the room or small flat, meals, house work, and staff who are on site day and night. Heat, light, and upkeep of the building sit inside the fee, not on top of it.

That bundle is why the fee looks high at first glance. You are not just buying care hours. You are buying a place to live, three meals a day, and help that is there at 3 a.m. without a new booking.

But the base fee may not cover all care. Many homes charge more as care needs grow. Help with baths, dressing, or medicines may sit in a higher care level, with a higher fee. Ask each home, in plain terms:

Get the answers in writing before you compare one home with the next. Two homes with the same base fee can end with very different total bills.

• What does the base monthly fee cover?
• What care tasks cost extra, and how much extra?
• Does the fee rise if needs grow, and by how much?
• Is there a one-time move-in fee?

The two bills, side by side

CareScout's Cost of Care Survey 2025 gives national medians for both kinds of care. A median is the middle figure: half of those surveyed charged more, and half charged less. Rates vary a lot by state and by town, so use these medians as a starting point, then get local quotes.

At the $35 per hour median for home care, the monthly sums are:

Assisted living, at its median of $6,200 per month, costs $74,400 a year. Home care at 44 hours a week costs $80,080 a year at the median rate — more than the assisted living year, and it still does not cover the nights or the house costs.

Read that pattern with care. When help is light — a few hours a day, a few days a week — home care costs far less than a move, and the person stays in a home they love. As hours grow, the home care bill climbs hour by hour, while the residential fee stays much the same. At about forty hours a week, the aide bill alone is about the same as the full assisted living fee. Past that point, residential care often costs less, and it covers far more hours.

• Ten hours a week: about $1,517 a month.
• Twenty hours a week: about $3,033 a month.
• Forty hours a week: about $6,067 a month.

How needs change the math

The crossover is not fixed. It moves with three things in your own life.

How much help is needed at night. Home care at night is costly, since each night hour is billed like a day hour. In a care home, night staff are part of the fee. A person who needs help twice a night, every night, shifts the math toward residential care fast.

How safe the home is on its own. If a person can be alone for long stretches and is safe, home care hours can stay low. If a person cannot be left alone at all, some care is needed in every hour of the day, and the hourly bill shows it.

How needs grow over time. Needs tend to rise, not fall. Run two sums: the cost at today's hours, and the cost if hours double. If the second sum breaks the budget, look at residential care now, while there is time to choose well and not in a rush after a fall.

There is no shame in either choice. Some pay more to stay home, and judge it worth the price. Some move and find the shared meals and staff on site a relief. The point of the sums is to choose with open eyes.

Who covers what

• Medicare: Original Medicare does not pay for long-term care, also called custodial care. Medicare.gov states that, since most long-term care is non-medical, Medicare and most health insurance do not pay for long-term care services, at home, in the community, or in a nursing home. You pay all costs for care Medicare does not cover, including most long-term care. Medicare does pay for short-term skilled care in set cases. Its home health benefit covers part-time skilled nursing or therapy at home when a doctor orders it and the rules are met. It does not pay for 24-hour care at home, meal delivery, or custodial care when that is the only care you need.
• Medicaid: you may be able to get long-term care through Medicaid if you meet your state's rules. States can run home and community-based services waiver programs, often called HCBS waivers. Medicaid.gov states that these waivers let people get long-term care services in their home or community, rather than in an institution. Waiver services can include case management, homemaker help, home health aide care, personal care, adult day health services, and respite care. In many states, waiver services can also help with care in assisted living. But Medicaid does not pay for room and board in a community setting such as assisted living. The rent and meals part of the bill stays with you. Each state runs its own programs, sets its own rules, and may have waiting lists. Check with your state Medicaid office.
• Private pay: most home care and most assisted living is paid out of pocket, from income and savings. That is the figure your own sums should rest on. A long-term care insurance policy you already own may help with either kind of care, up to its caps and after its waiting period. Read the policy with care before you count on it.

Sample Situation

Margaret is 82 and lives in the house she has owned for years. She needs help with baths, meals, and house work, about fifteen hours a week. At her local agency's rate, close to the national median, that aide help costs her about $2,275 a month. She adds her house costs — food, heat, light, tax, and upkeep — on top of that in her budget book. The total still sits well below the fee at the assisted living home near her daughter, so she stays home and reviews the sums each six months. Her plan notes the trigger point: if her aide hours reach forty a week, the aide bill alone will match that home's kind of fee, and the family will look at a move again with fresh quotes in hand.

Your next step

When you are ready to see how care costs and coverage fit together, our Paying for Care section walks through who pays for what, step by step.

Sources

• https://www.carescout.com/cost-of-care
• https://www.medicare.gov/coverage/long-term-care
• https://www.medicare.gov/coverage/home-health-services
• https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c
• https://www.medicaid.gov/medicaid/home-community-based-services/downloads/1915c-hcbs-waiver-pay-financing-trends-mar2026.pdf